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Introduction: Our objective was to assess the effect of rapid diet-induced weight loss on the function of obese patients with osteoarthritis (OA) of the knee. Methods: Eighty patients with knee OA were recruited, 71 of them (89%) women. The mean (SD) BMI was 35.9 (5.1) kg/m2 , and the mean age was 62.6 (11.1) years. The patients were randomized to either a low-energy diet (LED, 3.4 MJ/day) or a control diet (5 MJ/day). The LED group had weekly dietary sessions, whereas the control group were given a booklet describing weight loss practices. Changes in body weight and body composition were examined as independent predictors of changes in knee OA symptoms. Symptoms were monitored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. Results: The LED and control groups lost a mean (SE) of 11.1% (0.6%) and 4.3% (0.6%) of weight, respectively, with the mean difference being 6.8% (95% CI: 5.5 to 8.1%; p < 0.0001). Half of the patients in the LED group achieved more than 10% weight loss, whereas none of those in the control group reached that target (p < 0.0001). The decrease in body fat percentage was higher in the LED group, 2.2 percentage points (1.5 to 3.0 percentage points; p < 0.0001). The total WOMAC index improved in the LED group (p < 0.0001) but not in the control group (p = 0.12); the mean difference was: -219.3 mm (-369.2 to -69.4 mm; p=0.005). The »number needed to treat« to ensure an improvement in WOMAC = 50% was 3.4 (2.1 to 8.8) patients. Changes in the total WOMAC index were best predicted by the reduction of body fat percentage, with a 9.4% (4.8 to 13.9%) improvement in WOMAC for each percent of body fat lost (p=0.0005). Conclusions: In our patients with knee OA, a weight reduction of 10% improved function by 28%. LED might be advantageous because of the rapidity of weight loss and a more significant loss of body fat.

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